The U.S. Preventive Services Task Force (USPSTF) has called for at least one-time screening of all people between the ages of 18 and 79 for the hepatitis C virus (HCV), in new recommendations published online March 2 in JAMA.
The task force published a final recommendation statement and evidence report on March 2, assigning a B recommendation for screening -- meaning there is high certainty of a net benefit -- in this broad population. The group also urged consideration of testing for people younger than 18 and older than 79, if appropriate. The guidance is in line with draft recommendations published in August.
An estimated 4.1 million people in the U.S. have a current or past hepatitis C infection, Stanford University health policy expert Dr. Douglas Owens and colleagues noted in the recommendation statement.
Anti-HCV antibody testing should be conducted and followed up with confirmatory polymerase chain reaction (PCR) testing. Most adults can be screened once, but those with risk factors should be tested periodically.
"There is limited information about the specific screening interval that should occur in persons who continue to be at risk for new HCV infection or how pregnancy changes the need for additional screening," the task force authors wrote.
The USPSTF's last recommendation statement was made in 2013: The group advised one-time screening for people between the ages of 45 and 65, as well as testing of people at high risk for being infected, such as those who inject drugs.
The task force explained that demographics for the disease have changed, with more younger people getting infected through drug use. Also, effective, safe, and curative treatment options are now available for hepatitis C.
Paving the way for reimbursement
The B recommendation from the USPSTF will pave the way for insurance reimbursement for hepatitis C testing, without cost-sharing by patients, according to an accompanying editorial also published in JAMA. Competition among drugmakers has resulted in a large decline in pricing for hepatitis C treatments and, therefore, greater availability, wrote Dr. Camilla Graham, an assistant professor of medicine at Harvard University, and Dr. Stacey Trooskin, PhD, an assistant professor of medicine at Penn Medicine.
In some states, flat-rate reimbursement plans are in place, further increasing access, they noted.
"Both the reduced price of hepatitis C regimens, which should make broader access to treatment more feasible, and the increase in HCV infections in younger people are compelling reasons for expanding HCV screening at this time," Graham and Trooskin wrote.
The USPSTF's new stance is similar to recommendations by the American Association for the Study of Liver Diseases and the Infectious Diseases Society of America, as well as draft guidance from the U.S. Centers for Disease Control and Prevention, noted the authors of another editorial published in JAMA Network Open on March 2.
"We commend the USPSTF for taking such a bold step in the fight against HCV," wrote Eli Rosenberg, PhD, an associate professor of epidemiology and biostatistics at the University at Albany, and Dr. Joshua Barocas, an assistant professor of medicine at Boston University.
But while the recommendations are a "necessary step," they are not enough, as there is a need for repeated assessment of risk for some people, the authors suggested.
"We must acknowledge that individual and societal risk factors are always evolving, and our approach to screening should be to continually reassess both," Rosenberg and Barocas wrote.
Similarly, University of California, San Francisco (UCSF) hepatologists Dr. Jennifer Price, PhD, and Dr. Danielle Brandman commented that the changes are a step forward but more work is needed, in an editorial published in JAMA Internal Medicine on March 2.
"Implementation of HCV screening and linkage to treatment requires large-scale coordinated efforts, innovation, and resources," Price and Brandman wrote. "For example, point-of-care HCV RNA testing would enable scale-up of HCV screening and confirmatory testing among individuals at greatest risk of HCV infection."
There also remains a need to remove barriers between diagnosis and treatment and to ensure access to care for marginalized populations, they pointed out.